When considering the world's worst killers, alcohol likely doesn't come to mind. Yet alcohol kills more than 2.5 million people annually, more than AIDS, malaria or tuberculosis.

For middle-income people, who constitute half the world's population, alcohol is the top health risk factor, greater than obesity, inactivity and even tobacco.

The World Health Organization has meticulously documented the extent of alcohol abuse in recent years and has published solid recommendations on how to reduce alcohol-related deaths, but this doesn't go far enough, according to Devi Sridhar, a health-policy expert at the University of Oxford.

In a commentary appearing on Feb. 15 in the journal Nature, Sridhar argues that the WHO should regulate alcohol at the global level, enforcing such regulations as a minimum drinking age, zero-tolerance drunken driving, and bans on unlimited drink specials. Abiding by the regulations would be mandatory for the WHO's 194 member states.

Far from prohibition, the WHO regulations would force nations to strengthen weak drinking laws and better enforce laws already in place, Sridhar says.

Approaching a bottle a day

Alcohol consumption is measured in terms of pure ethyl alcohol to compensate for the varying strengths of beer, wine and spirits. A liter bottle of wine with 10 percent alcohol, for example, would be only 0.1 liter of pure alcohol. According to the WHO, Americans each drink 9.4 liters of ethyl alcohol per year on average. That's equivalent to 94 bottles of the aforementioned wine. [See list of top 20 booze-consuming countries]

As high as that might sound, Americans don't even crack the top 50 on the world charts. Europe, in particular Eastern Europe, dominates the drinking scene. Moldova has the top drinkers, downing 18.4 liters of alcohol per capita yearly. That's equivalent to 184 1-liter bottles of wine, or nearly four bottles a week per person. The legal drinking age in Moldova is 16, and there are few restrictions on when or where alcohol can be sold.

The price of such alcohol abuse is early death. One in five men in the Russian Federation and neighboring European countries dies as a result of alcohol, according to WHO data. Alcohol abuse is associated with cardiovascular diseases, cirrhosis of the liver, various cancers, violence and vehicle accidents. Alcoholic adults have difficulty working and supporting their families, too.

Sobering recommendations

Sridhar argues that the WHO is unique among health organizations in that it can create legally binding conventions. The WHO has done this only twice in its 64-year history: the International Health Regulations, which require countries to report certain disease outbreaks and public-health events; and the Framework Convention on Tobacco Control, which commits governments to making legislative moves to reduce the demand for, and the supply of, tobacco.

No other entity can attack the global problem of alcohol abuse, she said. When it comes to alcohol, though, the WHO has settled on merely recommendations, such as those outlined in the 2010 WHO Global Strategy to Reduce Harmful Use of Alcohol.

"Countries are aware of the problem, but several haven't made a real commitment to implementing the recommendations," Sridhar told LiveScience. "The problem is not with ministries of health but with ministries of finance, trade, etc. who prioritize other interests first."

In her Nature commentary, Sridhar said that the existing WHO recommendations could serve as the framework for a new international convention on alcohol regulation. Yet even the United States would struggle to meet several of the 10 recommended target areas, which include advertising restrictions, price hikes and tougher laws against drunken driving.

"Ministries of health would have a stronger domestic negotiating position in prioritizing alcohol regulation above economic concerns," with the WHO muscle behind them, she wrote.